You must have at least 2 (or more) of these symptoms. Each must be present for a significant portion of time during a 1-month period (less if the symptoms have been treated). At least 1 of the minimum 2 symptoms must be delusions, hallucinations, or disorganized speech.
There’s a difference between delusions and suspicions. Many people will occasionally have irrational suspicions, such as believing a co-worker is “out to get them” or that they’re having an “unlucky streak. ” The difference is whether these beliefs cause you distress or make it hard to function. For example, if you are so convinced that the government is spying on you that you refuse to leave your house to go to work or school, that is a sign that your belief is causing dysfunction in your life. [4] X Research source Seeman, M. V. (2015). On Delusion Formation. Canadian Journal of Psychiatry, 60(2), 87–90. Delusions may sometimes be bizarre, such as believing you’re an animal or a supernatural being. If you find yourself convinced of something beyond the usual realms of possibility, this could be a sign of delusions (but is certainly not the only possibility).
For example, consider whether you frequently experience the sensation of things crawling over your body. Do you hear voices when no one is around? Do you see things that “shouldn’t” be there, or that no one else sees?
For example, a belief that wicked actions will be punished by “fate” or “karma” might seem delusional to some cultures but not to others. [7] X Research source Bhugra, D. , & Kalra, G. (2010, July). Cross-Cultural Psychiatry: Context and Issues. Journal of Pakistan Psychiatric Society, pp. 51–54. What count as hallucinations are also related to cultural norms. For example, children in many cultures can experience auditory or visual hallucinations – such as hearing the voice of a deceased relative – without being considered psychotic, and without developing psychosis later in life. [8] X Research source Liester, M. B. (1998). Toward a new definition of hallucination. American Journal of Orthopsychiatry, 68(2), 305–312. [9] X Research source Mertin, P. , Niamh. (2013). High emotional arousal and failures in reality monitoring: Pathways to auditory hallucinations in non-psychotic children? Scandinavian Journal of Psychology, 54(2), 102–106. Highly religious people may be more likely to see or hear some things, such as hearing the voice of their deity or seeing an angel. Many belief systems accept these experiences as genuine and productive, even something to be sought after. Unless the experience distresses or endangers the person or others, these visions are not generally a cause for concern. [10] X Research source Reed, P. , & Clarke, N. (2014). Effect of religious context on the content of visual hallucinations in individuals high in religiosity. Psychiatry Research, 215, 594–598
In the most severe cases, speech may be “word salad,” strings of words or ideas that are not related and do not make sense to listeners. [12] X Trustworthy Source Mayo Clinic Educational website from one of the world’s leading hospitals Go to source As with other symptoms in this section, you must consider “disorganized” speech and thinking must be considered within your own social and cultural context. [13] X Research source Scull, A. (2014). Cultural Sociology of Mental Illness: An A-to-Z Guide. SAGE Publications For example, some religious beliefs hold that individuals will speak in strange or unintelligible language when in contact with a religious figure. Furthermore, narratives are structured very differently across cultures, so stories told by people in one culture may appear “weird” or “disorganized” to an outsider who is unfamiliar with those cultural norms and traditions. [14] X Research source American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, p. 103. Your language is likely to be “disorganized” only if others who are familiar with your religious and cultural norms cannot understand or interpret it (or it occurs in situations in which your language “should” be understandable).
Catatonia is another sign of abnormal motor behavior. In severe cases of schizophrenia, you may remain still and silent for days on end. Catatonic individuals will not respond to external stimuli, such as conversation or even physical prompting, such as touching or poking. [17] X Research source Sixt, B. , van Aaken, C. , Hennighausen, K. , Fleischhaker, C. , & Schulz, E. (2013). Severe catatonic schizophrenia in a 17-year-old adolescent female. In N. Boutros & N. (Ed) Boutros (Eds. ), The international psychiatry and behavioral neurosciences yearbook - 2012, Vol 2. (pp. 55–63). Hauppauge, NY, US: Nova Biomedical Books.
Negative symptoms may also be cognitive, such as difficulty concentrating. These cognitive symptoms are usually more self-destructive and more obvious to others than the inattentiveness or concentration trouble typically seen in people diagnosed with ADHD. [19] X Research source Freedman, J. L. Z. (2012). Pseudo-ADHD in a Case of First-Episode Schizophrenia: Diagnostic and Treatment. Harvard Review of Psychiatry (Taylor & Francis Ltd), 20(6), 309–317. Unlike ADD or ADHD, these cognitive difficulties will occur across most types of situations that you encounter, and they cause significant problems for you in many areas of your life.
Work/Academics Interpersonal relations Self-care
Do you feel psychologically able to leave the house to go to work or school? Have you had a hard time coming in on time or showing up regularly? Are there parts of your work that you now feel afraid to do? If you are a student, is your academic performance suffering?
Do you enjoy the same relationships you used to? Do you enjoy socializing in the way you used to? Do you feel like talking with others significantly less than you used to? Do you feel afraid or intensely worried about interacting with others? Do you feel like you’re being persecuted by others, or that others have ulterior motives toward you?
You have started or increased abusing substances such as alcohol or drugs You don’t sleep well, or your sleep cycle varies widely (e. g. , 2 hours one night, 14 hours the next, etc. ) You don’t “feel” as much, or you feel “flat” Your hygiene has gotten worse You don’t take care of your living space
This period must include at least 1 month of “active-phase” symptoms from Part 1 (Criterion A), although the 1-month requirement may be less if symptoms have been treated. This 6-month period may also include periods of “prodromal” or residual symptoms. During these periods, the symptoms may be less extreme (i. e. , “attenuated”) or you may experience only “negative symptoms” such as feeling less emotion or not wanting to do anything.
Your clinician will ask if you have had major depressive or manic episodes at the same time as your “active-phase” symptoms. A major depressive episode involves at least one of the following for a period of at least 2 weeks: depressed mood or loss of interest or pleasure in things you used to enjoy. It will also include other regular or near-constant symptoms in that time frame, such as significant weight changes, disruption in sleeping patterns, fatigue, agitation or slowing down, feelings of guilt or worthlessness, trouble concentrating and thinking, or recurrent thoughts about death. A trained mental health professional will help you determine whether you have experienced a major depressive episode. A manic episode is a distinct period of time (usually at least 1 week) when you experience an abnormally elevated, irritated, or expansive mood. You will also display at least three other symptoms, such as decreased need for sleep, inflated ideas of yourself, flighty or scattered thoughts, distractibility, increased involvement in goal-directed activities, or an excessive involvement in pleasurable activities, especially those with a high risk or potential for negative consequences. A trained mental health professional will help you determine whether you have experienced a manic episode. You will also be asked how long these mood episodes lasted during your “active-phase” symptoms. If your mood episodes were brief in comparison to how long the active and residual periods lasted, this may be a sign of schizophrenia.
Even legal, prescribed medications can cause side effects such as hallucinations. It’s important for a trained clinician to diagnose you so that s/he can distinguish between side effects from a substance and symptoms of an illness. Substance use disorders (commonly known as “substance abuse”) commonly co-occur with schizophrenia. Many people suffering from schizophrenia may attempt to “self-medicate” their symptoms with medication, alcohol, and drugs. Your mental health professional will help you determine if you have a substance use disorder. [25] X Research source Gouzoulis-Mayfrank, E. , & Walter, M. (2015). Schizophrenia and addiction. In G. Dom, F. Moggi, G. (Ed) Dom, & F. (Ed) Moggi (Eds. ), Co-occurring addictive and psychiatric disorders: A practice-based handbook from a European perspective. (pp. 75–86). New York, NY, US: Springer-Verlag Publishing.
If there is a history of autism spectrum disorder or other communication disorders that begin in childhood, a diagnosis of schizophrenia will only be made if there are prominent delusions or hallucinations present.
It is also possible, as mentioned before, that your symptoms could be the result of another trauma, illness, or disorder. You must seek professional medical and mental health help to properly diagnose any disorder or disease. Cultural norms and local and personal idiosyncrasies in thought and speech can affect whether your behavior appears “normal” to others. [28] X Research source Rashed, M. A. (2013). Psychiatric Judgments Across Cultural Contexts: Relativist, Clinical-Ethnographic, and Universalist-Scientific Perspectives. Journal of Medicine & Philosophy, 38(2), 128–148.
The Counselling Resource Mental Health Library has a free version of the STEPI (Schizophrenia Test and Early Psychosis Indicator) on their website. [30] X Research source Psych Central has an online screening test as well. [31] X Research source
Your physician can also help you rule out other causes of symptoms, such as injury or illness.
Discuss your family history and medical background with your doctor or mental health provider.
If you have an identical twin with schizophrenia, or if both of your parents have been diagnosed with schizophrenia, your risk of developing it yourself is more like 40-65%. However, about 60% of people who are diagnosed with schizophrenia do not have close relatives who have schizophrenia. If another family member – or you – has another disorder similar to schizophrenia, such as a delusional disorder, you may be at higher risk for developing schizophrenia. [34] X Research source
Infants who experience a lack of oxygen during birth may also be more likely to develop schizophrenia. Infants who are born during a time of famine are more than twice as likely to develop schizophrenia. This may be because malnourished mothers cannot get enough nutrients during their pregnancy. [36] X Research source
It is thought that this may be because the older the father is, the more likely his sperm is to develop genetic mutations.
